<div class="form">

<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'representante-legal-form',
	'enableAjaxValidation'=>false,
)); ?>

	<p class="note">Los campos con <span class="required">*</span> son requeridos:</p>

	<?php echo $form->errorSummary($model); ?>
	
		<div class="row">	<div class="col-md-7">
	
	<div class="panel panel-primary">
			<div class="panel-heading">
				 <h3 class="panel-title"><span class="glyphicon glyphicon-barcode"></span>&nbsp;&nbsp; </h3>
	
			</div>
	<div class="panel-body">
	 
		<?php echo $form->labelEx($model,'NOMBRE'); ?>
        <?php echo $form->textField($model,'NOMBRE',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
		<?php echo $form->error($model,'NOMBRE'); ?>
	</div>
	
	<div class="panel-body">
		<?php echo $form->labelEx($model,'APP'); ?>
        <?php echo $form->textField($model,'APP',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
		<?php echo $form->error($model,'APP'); ?>
	</div>

	<div class="panel-body">
		<?php echo $form->labelEx($model,'APM'); ?>
        <?php echo $form->textField($model,'APM',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
	    <?php echo $form->error($model,'APM'); ?>
	</div>

	<div class="panel-body">
		<?php echo $form->labelEx($model,'FEC_NAC'); ?>
        <?php echo $form->textField($model,'FEC_NAC',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
		<?php echo $form->error($model,'FEC_NAC'); ?>
	</div>
	
	<div class="panel-body">
		<?php echo $form->labelEx($model,'CURP'); ?>
        <?php echo $form->textField($model,'CURP',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
				<?php echo $form->error($model,'CURP'); ?>
	</div>
	

	<div class="panel-body">
		<?php echo $form->labelEx($model,'RFC'); ?>
        <?php echo $form->textField($model,'RFC',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
				<?php echo $form->error($model,'RFC'); ?>
	</div>
	

	<div class="panel-body">
		<?php echo $form->labelEx($model,'DOMICILIO'); ?>
        <?php echo $form->textField($model,'DOMICILIO',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
		<?php echo $form->error($model,'DOMICILIO'); ?>
	
	</div>

	<div class="panel-body">
		<?php echo $form->labelEx($model,'TELEFONO'); ?>
        <?php echo $form->textField($model,'TELEFONO',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
				<?php echo $form->error($model,'TELEFONO'); ?>
	</div>

	<div class="panel-body">
		<?php echo $form->labelEx($model,'CORREO_ELECTRONICO'); ?>
        <?php echo $form->textField($model,'CORREO_ELECTRONICO',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
		<?php echo $form->error($model,'CORREO_ELECTRONICO'); ?>
	</div>
	

	<div class="panel-body">
		<?php echo $form->labelEx($model,'ACTIVO'); ?>
		<?php echo $form->dropDownList($model, 'ACTIVO',array('1'=>'Disponible', '0'=>'No disponible'), array('class'=>'form-control')); ?>
		<?php echo $form->error($model,'ACTIVO'); ?>
	</div>
	

<div class="panel-body">
		<?php echo $form->labelEx($model,'NSS'); ?>
        <?php echo $form->textField($model,'NSS',array('class'=>'form-control', 'size'=>60,'maxlength'=>300, 'placeholder'=>' ')); ?>
				<?php echo $form->error($model,'NSS'); ?>
	
<BR>
     	<?php echo CHtml::submitButton(UserModule::t("Aceptar"), array('class'=>"btn btn-primary ")); ?>
		</div>
	
	</div>
	</div>

<?php $this->endWidget(); ?>

</div><!-- form -->